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Use of Ondansetron for Vomiting After Head Trauma: Does It Mask Clinically Significant Traumatic Brain Injury?
Israel Green-Hopkins1, Michael C Monuteaux2, Lois K Lee2
1From the Division of Pediatric Emergency Medicine, UCSF Benioff Children's Hospital, San Francisco, CA.
Insights
Ondansetron use in pediatric head trauma patients not needing imaging was linked to more return visits and admissions. However, the study found no significant differences in missed serious injuries, though it was underpowered to confirm this.
Area of Science:
- Pediatric Emergency Medicine
- Clinical Pharmacology
- Trauma Care
Background:
- Head injuries are common in children presenting to emergency departments.
- Ondansetron is frequently used to manage nausea and vomiting in these patients.
- The safety and efficacy of ondansetron in children with head trauma require further investigation.
Purpose of the Study:
- To examine the utilization of ondansetron in children with head injuries.
- To assess the association between ondansetron use and subsequent return visits and diagnoses of intracranial injuries.
- To evaluate the impact of ondansetron on outcomes in pediatric head trauma patients.
Main Methods:
- Retrospective analysis of 218,904 pediatric head injury encounters (ages 6 months to 18 years) from 2009-2013.
- Evaluation of ondansetron administration rates and its correlation with return visits within 72 hours.
- Comparison of outcomes including admission rates, skull fractures, and intracranial injuries between ondansetron-treated and non-treated groups.
Main Results:
- Ondansetron was administered in 2.8% of encounters, with significant hospital-level variation.
- Patients receiving ondansetron were more likely to return within 72 hours (3.7% vs 1.9%) and be admitted (7% vs 4%).
- No significant differences were observed in rates of skull fractures, intracranial injuries, or operative interventions.
Conclusions:
- Ondansetron use in pediatric head trauma patients not requiring neuroimaging is associated with increased return visits and admissions.
- The study was underpowered to detect significant differences in missed critical injuries.
- Further research with larger cohorts is needed to definitively assess the impact of ondansetron on detecting serious intracranial injuries.
Objectives:
We describe ondansetron use in children with head injury evaluated in pediatric emergency departments and its association with return visits and late diagnoses of intracranial injuries requiring intervention.
Methods:
Children ages 6 months to 18 years discharged without neuroimaging from 35 pediatric emergency departments with a diagnosis of head injury from 2009 to 2013 were identified retrospectively from the Pediatric Health Information System. We evaluated the rates of ondansetron use during the study period and of the association of ondansetron treatment with the diagnosis of intracranial injury, skull fracture, and return visits within 72 hours requiring admission or operative intervention.
Results:
We identified 218,904 encounters during the study period. Of these, 5894 patients (2.8%) were given ondansetron. There was significant variation in the use of ondansetron during the index visit between hospitals (0.1%-5.7%), and ondansetron use significantly increased over the study period. Return visits within 72 hours were more likely for patients treated with ondansetron during the index visit (3.7% vs 1.9%; adjusted odds ratio, 1.99; 95% confidence interval, 1.7-2.4). These patients were more likely to be admitted than those not treated initially with ondansetron (7% vs 4%; adjusted odds ratio, 1.97; 95% confidence interval, 1.09-3.55). There were no significant differences in rates of skull fractures, intracranial injury, intensive care unit admission, or operative intervention between groups.
Conclusions:
Ondansetron use during an initial emergency department visit for head trauma in children not requiring neuroimaging is associated with a higher likelihood of return within 72 hours and subsequent admission. There were no differences in rates of missed skull fractures, intracranial injury, intensive care admission, or operative intervention for groups who were and were not treated with ondansetron; however, this study was underpowered to detect significant differences in these categories. Future investigations with greater numbers would be required to confidently assess these critical differences.
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